Night Camp Registration Form

Name of Parent/Guardian

First Name

Last Name

Relationship to Child

Address

Email

Phone

(###)

###

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Allergies

Hay Fever

Bee Sting

None

Other allergies:

Dietary Restrictions

Medical info to be aware of:

Camper Name:

First Name

Last Name

Grade Entering in Fall:

Birthday

MM

DD

YYYY

Alternative Pickup Contact Names:

First Name

Last Name

Phone

(###)

###

####

Alternative Pickup Contact Names:

First Name

Last Name

Phone

(###)

###

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